1124667266 NPI number — MR. PRINTESS JOHN LAWRENCE FNP

Table of content: MR. PRINTESS JOHN LAWRENCE FNP (NPI 1124667266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124667266 NPI number — MR. PRINTESS JOHN LAWRENCE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
PRINTESS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124667266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PROSPERITY LANE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-831-0073
Provider Business Mailing Address Fax Number:
304-831-0471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PROSPERITY LANE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-831-0073
Provider Business Practice Location Address Fax Number:
304-831-0471
Provider Enumeration Date:
01/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  105060 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com